=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932096625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANAVA HOSPITALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 N 3RD ST
-----------------------------------------------------
City | MACCLENNY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32063-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-259-3151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1640 ABERDEEN ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32205-8636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-515-3119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GRANT BARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-515-3119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------